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Yesterday, I read two articles in JAMA on pimping. (Yes, I still get JAMA.) The article suggested that pimping medical students and residents may be “old school.” Used inappropriately, it may serve more as a tool off abuse and humiliation as opposed to a pedagogical art.

Duh.

Anything used inappropriately can be viewed as abusive or, well…er, inappropriate.

That includes language, relationships, guns, medications….The list is long.

First, to those reading this who believe I am talking about business oversight of prostitutes. Nope. In medicine, pimping is the art of asking those junior to you rapid-fire medical questions. About your patient. About patient care. About medical trivia. About ontogeny recapitulating phylogeny.

It’s a rite of passage. And it is often stressful.

For those teachers who are using it the right way, they hope their students will “come to class” prepared. Most teachers want curious students to learn and succeed. It’s actually less time consuming to just pass the below-average medical student and make him/her someone else’s problem down the road. Pimping is labor intensive for both the pimper and the pimpee. The pimper has to remember the Krebs cycle and brachial plexus anatomy to stump the pimpee.

Socrates used the same techniques.

Next, pimping gets the student used to stress. Practicing medicine is stressful. Taking care of patients is not easy. Why pretend otherwise? Keeping medical students and residents in a cocoon will only delay that day of reckoning. If doctors are to perform, they need to be tested. This is no different for military personnel, police officers, and professional athletes.

Does pimping have other less beneficial purposes? Of course. When I took my oral neurosurgical boards, each session had two examiners. In one session, one of my examiners had been in practice for decades. He was seasoned with gray hair. He believed his job was to ensure I would represent the field honorably. He wanted to make sure my judgment was sound and that I would not hurt any patients.

The other examiner was green. He had graduated from his neurosurgical residency a few years earlier. He was junior faculty at an academic institution. And, he was working his way up the food chain. The questions he asked were nothing like those of his more senior colleague.

I was being pimped.

I got the impression his questions had more to do with impressing his senior colleague, than actually testing me.

Still, I passed.

A rite of passage.

If a pimper is focused solely on humiliation and abuse and has no interest in pedagogy, then, that person has no place in teaching. But, most pimpers believe a greater goal is being served.

My vote: Let the pimping continue. What do you think?

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